Comparative Effectiveness of Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention for Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Clinical Trials

Abstract

Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are the options for revascularization in coronary artery disease (CAD). This meta-analysis aims to compare the efficacy of CABG and PCI for the management of patients with CAD. The meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, and EMBASE were searched for relevant articles. The reference list of included articles was also searched manually for additional publications. Primary endpoints were cardiovascular mortality and all-cause mortality. Secondary endpoints included myocardial infarction, stroke, and revascularization. In total, 12 randomized control trials (RCTs) were included in this meta-analysis encompassing 9,941 patients (4,954 treated with CABG and 4,987 with PCI). The analysis showed that PCI was associated with a higher risk of all-cause mortality (risk ratio (RR) = 1.26, 95% confidence interval (CI) = 1.10-1.45) and revascularization (RR = 2.42, 95% CI = 1.82-3.21). However, no significant differences were reported between two arms regarding cardiovascular mortality (RR = 1.15, 95% CI = 0.96-1.39), myocardial infarction (RR = 1.17, 95% CI = 0.82-1.67), and stroke (RR = 0.64, 95% CI = 0.35-1.16). CABG was associated with a significant reduction in all-cause mortality and revascularization compared to PCI. However, no significant difference was reported in the risk of cardiovascular mortality, myocardial infarction, and stroke between the two groups.

Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials

“…The study by Ganyukov et al (2023), Wang et al (2023), and De Winter et al (2023) also favored CABG, indicating overall that CABG is more efficacious than PCI. In a study [ 35 ] which was a meta-analysis conducted in 2021, the revascularization rate was also compared among the treatment groups, but the studies used were all observational studies. Our meta-analyses used only RCTs, which eliminates the risk of confounding bias, making it highly unlikely.…”

Effectiveness of non‐pharmacological interventions in improving sleep quality after cardiac surgery: A systematic review and meta‐analysis

“…For the treatment of coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) have been the common surgical options. Studies in recent years compared the effectiveness of CABG and PCI, and while PCI provides a less invasive approach with fewer risks, CABG demonstrated a survival advantage with significant reduction in revascularisations and mortality especially in multivessel disease (Shaik et al., 2022). With the rising association of CAD and valvular heart disease (Matta & Moussallem, 2019), valve repair and valve replacement surgeries can be combined with CABG with favourable outcomes (Ahmed et al., 2021).…”

Comparison of Early and Long-Term Mortality in Patients With Reduced and Preserved Ejection Fraction Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis

“…Presently, the all-cause mortality rate stands at 1% for patients with preserved ejection fraction (EF), increasing to 7% for those with severely reduced EF [ 1 ]. Managing patients with low EF remains challenging, although CABG has shown superiority over medical therapy alone, leading to significant clinical improvement and long-term survival [ 2 , 3 ]. However, patients with reduced EF experience higher postoperative morbidity and mortality rates compared to those with normal left ventricular function [ 4 ].…”